Effectiveness of exercise therapy versus manual therapy in chronic low back pain : A Systematic Review

Registration ID: IJNRD_324892

Published ID: IJNRD2605373

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Aditi singh, Kunal Choudhary, Alka

: chronic low back pain, exercise therapy, manual therapy, spinal manipulation, stabilisation exercises, graded activity, functional disability, Oswestry Disability Index, systematic review, biopsychosocial model

Background: Chronic low back pain (CLBP) is among the most prevalent and disabling musculoskeletal conditions worldwide, imposing substantial clinical and socioeconomic burdens. Exercise therapy and manual therapy represent two of the most widely employed physiotherapeutic interventions for its management, yet comparative evidence regarding their relative effectiveness remains a subject of ongoing clinical debate. Objectives: This systematic review critically synthesises evidence from randomised controlled trials, systematic reviews, and meta-analyses to compare the clinical effectiveness of exercise therapy and manual therapy in adults with CLBP across pain intensity, functional disability, range of motion, and return-to-work outcomes. Methods: A comprehensive narrative synthesis was conducted, drawing on eleven high-quality published sources including Cochrane reviews, meta-analyses, and clinical guidelines. Relevant studies were selected based on pre-defined inclusion criteria encompassing adult populations, chronic low back pain duration of more than twelve weeks, and use of validated outcome measures including the Visual Analogue Scale (VAS), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and spinal range of motion assessments. Results: Both exercise therapy and manual therapy produced statistically significant improvements over no-treatment or usual care conditions for CLBP. Exercise therapy demonstrated strong evidence of superiority over standard general practitioner care and equivalent effectiveness to conventional physiotherapy. Manual therapy, particularly spinal manipulative therapy and mobilisation, showed superior short-term pain reduction and substantially better return-to-work outcomes in direct head-to-head comparison with general exercise. Stabilisation exercises demonstrated clinical equivalence to manual therapy in pain and disability outcomes. The combination of manual therapy with specific adjuvant exercise produced the most clinically significant pain reductions, surpassing either intervention delivered in isolation. Intensive multidisciplinary biopsychosocial rehabilitation demonstrated the strongest evidence for severely disabled CLBP populations. Conclusion: Neither exercise therapy nor manual therapy emerges as categorically superior across all CLBP presentations. Clinical decision-making should be guided by patient subgroup characteristics, chronicity severity, psychosocial profile, and functional goals. A multimodal approach combining targeted exercise with manual therapy — delivered within a biopsychosocial framework — represents the most evidence-supported protocol for CLBP rehabilitation. - published between 1997–2016, identified through MEDLINE, EMBASE, Cochrane, CINAHL, and PEDro databases.

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Aditi singh, Kunal Choudhary, & Alka (May-2026). Effectiveness of exercise therapy versus manual therapy in chronic low back pain : A Systematic Review . INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 11(5), d648-d663. https://ijnrd.org/papers/IJNRD2605373.pdf

Volume 11 Issue 5, May-2026

Pages : d648-d663

Paper Reg. ID: IJNRD_324892

Published Paper Id: IJNRD2605373

Research Area: Medical Science All

Author Type: Indian Author

Country: Jaipur , Rajasthan , India

Published Paper PDF: https://ijnrd.org/papers/IJNRD2605373.pdf

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